Two national coalitions, two approaches to universal health insurance

BY KIP SULLIVAN

The 2009 session was a good year for the single-payer movement in Minnesota. The authors of the MHA, Sen. John Marty (DFL-Roseville) and Rep. Bly, had 29 Senate co-authors and 35 House co-authors as of March 1. That’s almost one-third of the state’s 201 legislators. It was heard in three committees, and it cleared two of them (both in the Senate). The attention of single-payer supporters now shifts to Congress where Democrats have vowed to pass health care reform legislation through both houses by August. Although the single-payer bill in the U.S. House, HR 676, has 72 co-sponsors (including Rep. Keith Ellison of Minneapolis), and although Sen Bernie Sanders (Indepen-dent-Vt.) has authored a companion bill in the Senate, the White House and congressional Democrats who chair the relevant committees have so far refused to support single-payer legislation.

They are instead considering a proposal to create a public health insurance program like Medicare that would sell health insurance to the nonelderly in competition with existing health insurance companies. The proponents of this idea have yet to describe it in any detail, so it is impossible to predict how well this idea will work. It will at best save a little money, but it will make it politically difficult to achieve universal coverage. At worst, it could result in the bankruptcy of the Medicare-like program (see my article in the December 2008 edition of Southside Pride), which conservatives would use as a pretext to denigrate the claims made for single-payer systems.

The public-private-plan-choice proposal has the support of a large coalition
of organizations called Health Care for America Now (HC-AN). HCAN, which
announced its existence last July 8, supports universal health insurance, but not through a single-payer system.

Sonali Kolhatkar, a host on Uprising Radio, a daily news show on KPFK (part
of Pacifica Radio) in Los Angeles moderated a debate between Richard Kirsch,
HCAN’s director and Dr. David Himmelstein, the co-founder of the nation’s leading single-payer organization, Physicians for a National Health Program (which represents 15,000 doctors). Ms. Kolhatkar began the show noting that HCAN “is not for a single-payer system. Instead the coalition has opted to advocate for a more cautious heath care reform, giving the people a choice of remaining in private insurance plans or selecting a public health care policy.” “We are calling for a set of principles to provide quality affordable health care for all,” Mr. Kirsch began. “[To achieve that] we need to do a couple of things. First, we need to regulate the private insurance industry. Secondly, we have to offer people a choice of a public health insurance plan [or] private insurance.”

Dr. Himm-elstein replied, “To say you’re going to get quality affordable health care for everyone and keep the health insurance industry in the system is like saying we want delicious chocolate chip cookies without calories ... They’re prescribing something that’s easy to take but can’t work.” Dr. Himmelstein argued HCAN’s proposal fails to capture the enormous administrative savings that a single-payer system would create, and that other methods that HCAN is counting on to cut costs—including electronic medical records and “disease management”—have been found by reputable researchers, including the Congressional Budget Office, not to cut costs. Mr. Kirsch replied that HCAN’s proposal would cut costs. (You can listen to the Kirsch-Himmelstein debate at uprisingradio.org-/home/?p=2874) Because HCAN has not set forth a description of how their proposal would work, it is difficult to articulate what a compromise between the two sides might look like.

The most promising scenario for compromise is a bill that subsidizes the Medicare-like program so that it cannot be undersold, but that system could ultimately be bankrupted by the unethical and illegal tactics of the insurance industry. The greatest fear single-payer advocates have about HCAN’s public-private-plan proposal is that the Medicare-like plan will not only fail to force the private plans to become more efficient, but will itself be bankrupted because private plans will resort to rationing to drive sicker patients off their rolls and onto the rolls of the kinder, gentler Medicare-like program. If HCAN would endorse legislation that ensures that, at minimum, the Medicare-like program cannot be bankrupted and might even be able to drive the private insurers off the market,
single-payer supporters might be persuaded to view such a bill as a transition to a single-payer system.

Kip Sullivan writes frequently about health care reform. He is a member of the steering committee of the Minnesota chapter of Phy-sicians for a National Health Program.